When an Impartial Examination is Not Enough

A recent decision from the Department of Industrial Accidents’ reviewing board illustrates the sort of circumstances under which an impartial medical examiner’s report can and should be found insufficient. The case involved Mae Roscoe, a sixty-two year old phlebotomist who was injured while working for Brigham and Women’s Hospital. At issue in this case was what credibility the impartial medical examination should be given.

Impartial Medical Examinations in Massachusetts

As part of the workers’ compensation reforms passed in 1991, Massachusetts legislators introduced the concept of an impartial medical examination (IME) procedure in an attempt to get rid of conflicting medical reports submitted by employees and employers (which, as one would expect, tended to favor the individual or entity who paid for them). The IME procedure, as conceived by the legislature, would require an independent and impartial physician to be employed to examine the injured employee, review his or her medical records, and then render an opinion as to:

· Whether a disability exists;

· Whether the disability is total or partial, permanent or temporary; and

· Whether the injury is related to an injury arising out of the course of the employee’s work.

The legislature gave such IME reports “prima facie” weight, meaning that the judge that reviews such reports accepts them at their face value and typically does not consider other medical evidence or reports on those issues.

The Facts of Ms. Roscoe’s Case

On July 11, 2011, while moving a heavy medical cart out of a patient’s room, Ms. Roscoe struck her right knee against a device attached to the patient’s bed. She experienced an immediate pain and reported the injury to her employer. She began receiving treatment for her injury in August 2011. She was found to have a torn medial meniscus in her knee and underwent a partial medial meniscectomy in November that same year. Following this surgery, she underwent three Synvisc injections and physical therapy. At the time of her workers’ compensation hearing before the reviewing board, she had not returned to work.

In disputing the amount of benefits payable to her, Ms. Roscoe claimed her benefits should have begun July 12, 2011 (the day after her injury). The insurer disputed the extent of Ms. Roscoe’s injury and incapacity, as well as the relationship between her injury and the scope of her employment. The administrative judge, adopting in part the findings of the impartial medical examiner, found that Ms. Roscoe was entitled to benefits only from July 11, 2011 until July 6, 2012 (the date of her IME). Ms. Roscoe as well as the insurer appealed this decision to the reviewing board. In particular, Ms. Roscoe wished to present medical evidence in addition to the IME report.

An Inconsistent IME is Inadequate

The reviewing board found the report of the impartial medical examiner to be unclear and contradictory. In this case, the examiner found that Ms. Roscoe had “a meniscal tear and contusion” related to her work injury. However, later in the examiner’s report he references a knee “strain,” despite never diagnosing Ms. Roscoe with a knee strain. Other inconsistencies were found in the examiner’s report, such as where, in one paragraph, the examiner notes that Ms. Roscoe did not have any preexisting conditions and then arguing that her July 11 injury exacerbated a preexisting condition. The reviewing board found that because of these inconsistencies the administrative judge should not have relied on this report (should not have given it “prima facie” weight). The reviewing board ordered that the case be sent back to the administrative judge who would need to admit and consider the additional medical evidence Ms. Roscoe wanted. This could lead to her receiving additional benefits.

Contact us today at (508) 755-7535 for a free consultation if you have been injured on the job and are filing for workers’ compensation benefits. Workers’ compensation law is complex, and you need an experienced attorney to protect your rights and make sure you get the benefits to which you are entitled.

Client Testimonials

Attorney Ventura was excellent. I was injured in a car accident and he really looked out for my best interests. He is thorough and professional as well as easy to reach and always there when I needed him. His support team was outstanding. They kept me well-informed throughout the process. I would highly recommend Attorney Ventura for any of your personal injury needs. He’s the best.

Ann J.

Peter did an excellent job reviewing and handling my case. He was clear and honest regarding the legal climate and chances for a satisfactory outcome in

Steve

Attorney Ventura was without a doubt the best lawyer I have come across. I had a personal injury case that he handled and he did so very professionally and effectively. I simply can’t say enough good things about Attorney Ventura and his staff. There was such great attention to detail and I, as the client, always came first. I cannot recommend Attorney Ventura highly enough.

Types Of Injuries

Read Our Book

For more than 25 years, our client service philosophy has guided our work in every case:

We understand the anxiety and uncertainty that a Serious accident can cause for the victim and family. By establishing close communication with clients we serve, we try to inspire confidence in each client’s case.

Clients want meaningful results. Our goal is to achieve those results through dedication, hard work and a total commitment to professional excellence.

We protect the client’s interests by working with the very best professional experts- including medical specialists, investigators, photographers, vocational consultants, economists and accident reconstruction engineers. Our goal is to develop the detailed evidence necessary to convince insurance companies to pay just and fair compensation.

We are relentless in our pursuit of the truth and obtaining the best possible result as each case allows.

No Fee Unless We Win

We offer free consultations, and we accept nearly all of our cases on a contingent fee basis. In other words, you pay no attorneys fee except as a percentage of what we’re able to recover for you through settlement or trial.

The information on this website is for general information purposes only. Nothing on this site should be taken as legal advice for any individual case or situation. This information is not intended to create, and receipt or viewing does not constitute an attorney-client relationship.